An illuminating view of how PTSD really works

Waiting for First Light: My Ongoing Battle with PTSD

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Sigmund Freud observed that individuals can become fixated on their moment of trauma. The life of Roméo Dallaire is proof of this. Twenty-two years on from the Rwandan genocide, and a little over a decade since the publication of his first book on the conflict, Shake Hands with the Devil, he has written once more of a place and time that holds him captive. He begins his book Waiting for First Light: My Ongoing Battle with PTSD by placing his suffering alongside that of the Ancient Mariner, both men doomed by circumstances beyond their control to a life of emotional pain. This comparison is apt to begin with, but as the general’s past reveals, their shared path down the long road of sorrow diverges. There is an inspiring message embedded in Dallaire’s tale of woe, namely how resilience can kick in, lift a man out of a very dark place, and become the driving force for recovery and redemption. But I am getting ahead of myself.

The subtitle of Dallaire’s book is “My ongoing battle with PTSD.” The diagnosis of post-traumatic stress disorder first appeared in the third edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association in 1980. Emotional trauma, of course, has a much longer history, and antecedents to PTSD were called shell shock, battle fatigue and soldier’s heart (Da Costa syndrome), among other terms. What was significant about the DSM-III taxonomy, however, was that the core clinical features of the syndrome as we understand it today were for the first time clearly defined. Subsequent versions of the DSM, particularly the DSM-V in 2013, modified the 1980 criteria while leaving the central tenets intact.

Of late, as large numbers of veterans have returned home from wars in Afghanistan and Iraq and the struggles of some with the emotional fallout of combat have become evident, the spotlight has fallen on the disorder. So much has now been written on the topic that the letters PTSD have entered our vernacular. This recognition is to be welcomed, but with the important caveat that the diagnosis be applied correctly. One downside of this surge of interest is that the bar has been lowered, that PTSD is now bandied about as a catch-all for anyone who has had some kind of adverse life experience. This is patently absurd. It is therefore germane, when reading Dallaire’s book, to have a broad understanding of what those four little letters really mean and what kind of stressors qualify for inclusion.

Here the DSM-V is very clear. To receive the diagnosis of PTSD an individual must have been exposed to actual or threatened death, serious injury or sexual violence by directly experiencing the traumatic event(s), or witnessing, in person, the event(s) as they occurred to others. In response to this, a constellation of symptoms may arise, which from a diagnostic standpoint must include four discrete clusters: intrusion symptoms (such as unwanted intrusive memories or images, flashbacks and dreams), persistent avoidance of stimuli (such as efforts to avoid activities, places or physical reminders that arouse recollections of the traumatic events), negative thoughts (such as shame, guilt, confusion, sadness, social withdrawal) and alteration in arousal (such as irritability, poor concentration, difficulty falling and staying asleep, hypervigilance). When symptoms such as these coalesce in response to an overwhelming stressor, they can bring down a person very hard indeed. This is what befell General Dallaire. Those who read his first book will know some of this. Waiting for First Light reveals the full extent of his emotional collapse.

The great warriors of ancient Greece, Hercules and Ajax, were laid low not by combat, but by their homecomings. It was not lack of courage that was their undoing, but rather the routine of life away from the front lines.

Viewed with the wisdom of hindsight, the events that surround Dallaire’s time in Rwanda and his return to Canada read like a perfect storm, a series of institutional mistakes and at times exercises insheer idiocy that sucked a brave man into the PTSD vortex. In 1993, Dallaire was dispatched to Rwanda as commander of the United Nations Assistance Mission for Rwanda tasked with implementing the Arusha Peace Agreement between the warring parties. The road to damnation is paved with good intentions. Short of resources and manpower, and with his political masters in New York tying his hands, Dallaire was forced to stand by helplessly as the country descended into hell. “Meanwhile, all across Rwanda, murder, murder, murder, murder, murder, murder, murder, murder, murder,” wrote Phillip Gourevitch in his memorable book, We Wish to Inform You That Tomorrow We Will Be Killed with Our Families. It was on Dallaire’s watch that the murder was perpetrated in 1994. In three months, at least 800,000 Rwandans, mostly Tutsis, were slaughtered. When the killings were largely over, a shattered Dallaire asked to be relieved of his command. As he divulges, a request like this was unheard of. In making it, he felt like a failure, but was driven to do so by a realization that if he fell apart in the field, the effects on the mission and the troops he commanded, already stressed by their impotence in the face of mass murder, would be severe. Little did he know that his personal battle with mental illness was only beginning.

With the UNAMIR mission doomed to fail on a catastrophic scale, Dallaire returned to a Canadian military establishment blind to his distress. There was no trauma debriefing, but instead a prodigious workload in an army reeling from a breakdown in discipline within the Canadian Airborne Regiment in Somalia, as well asslashed budgets and escalating suicides in soldiers returning from peace­keeping missions in the Balkans. Along the way, work decisions and social circumstances separated the general from his wife and children, removing one of the most important buffers to psychological distress in someone who has been traumatized. Dallaire’s wife had not been schooled in how to cope with the wounded warrior who had returned home. The inability on the part of the Canadian military to appreciate the long arm of PTSD, to understand how spouses and children are affected too, is another of the many failings laid bare in this book. It is heartbreaking to picture the general, emotionally and physically spent, driving the 450 kilometres every Friday night between his office in Ottawa and his family in Quebec City, desperate for some time with his wife and children only to arrive feeling irritable and emotionally cut off from those he loves most. Reading these affecting passages one’s thoughts go to hisfamily as well, the tranquil beauty of Quebec City clearly no antidote to the pain of Rwanda brought home into their ­living room.

One can read into Dallaire’s long days at his desk an element of avoidance, a core PTSD feature. But,as days darkened into nights and the world around him slowed, the unwanted images of Rwanda could no longer be kept at bay. Sleep, rather than being restorative, unlocked the floodgates of memory—which is why Waiting for First Light is such a telling title for this cris de coeur memoir.

The challenges of leaving war behind and reintegrating into civil society have been frequently underestimated by the military. Sebastian Junger explores this theme in depth in his recent book, Tribe: On Homecoming and Belonging, and posits that the alienation felt by many returning veterans contributes to the development of their PTSD. The ancient Greeks knew this only too well. Their great warriors, Hercules and Ajax, were laid low not by combat, in which they excelled and for which they were richly honoured, but by their homecomings. These men of immense strength could not leave war behind them. It was not lack of courage that was their undoing, but rather the routine of life away from the front lines. While there are similarities between these Grecian legends and the fate of Roméo Dallaire, there is one important difference. Hercules and Ajax were welcomed back as heroes; the general was not. How could he be? There was a genocide to explain and, although the horror was clearly not of his making, it remains as a permanent stain on the conscience of the United Nations and the world community. Which brings me to the subject of moral injury. Dallaire gets to this late in his book, but from my reading of his personal journey, it is surely one of the factors that has caused him the greatest distress and, in turn, has been the impetus to positive actions that have given his life at present much meaning.

Roméo Dallaire suffered a great moral injury during his time in Rwanda. What he initially saw as his personal failing was really his own misplaced guilt. The failing lay elsewhere, among institutions and people far more powerful than a lieutenant general. While PTSD is not synonymous with moral injury, the two can be closely intertwined as Dallaire’s history reveals. As he set about painstakingly rebuilding his life after the nadir of an attempted suicide, moral injury appears to have been the catalyst for post-traumatic growth. Dallaire has lectured relentlessly on the Rwanda genocide, hoping to educate Canadians and those further afield on the subject. He has become a champion of wounded veterans. He was invited to a year-long fellowship at Harvard University by Samantha Power, author of “A Problem from Hell”: America and the Age of Genocide, then the director of the Carr Centre for Human Rights Policy. In 2007 he launched the Roméo Dallaire Child Soldiers Initiative, a global partnership based at Dalhousie University aimed at progressively eradicating the use and recruitment of child soldiers.

And yet, amid these accomplishments and many others, signs of fragility still peek through. We should not be surprised by this. Memories of genocide can never be forgotten. The best that can be hoped for is that their emotional sting lessens with time and therapy. As Waiting for First Light reveals, the general is not yet out of the woods, and, given what we know of the long-term effects of overwhelming psychological trauma, he may never be. No doubt he knows this too. All the more credit to him, therefore, that he has been able to seize the day and divert his decades of hurt into activities that provide succour and hope to those who, like him, carry war’s emotional scars.

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Anthony Feinstein is a professor of psychiatry at the University of Toronto and author of Journalists Under Fire: The Psychological Hazards of Covering War (Johns Hopkins University Press, 2006).